Paul and Pam Stroklund of Minot are raising their four grandsons-ages 12, 9, 7 and 2-because the boys' mother, their daughter, can't.
She is addicted to drugs, and is enrolled in a treatment program.
About 12 years ago, her doctor prescribed an opioid, oxycodone, for a medical condition, Paul Stroklund said.
"It was a lengthy prescription of oxy, and she was immediately hooked. She was on them for 39 days, and that just kind of started the process (of addiction).
"And then, when she couldn't get doctors to give her pills anymore, she was buying them from friends, or borrowing or stealing pills, or taking Mom and Dad's.
"About seven years ago, she graduated to heroin, because that was cheaper," Stroklund said.
His daughter has been in multiple treatment facilities and programs, he said. She is enrolled in an outpatient recovery program and doesn't live with her boys.
"It was a recommendation from one of the facilities she was in," said Stroklund said. "It's actually worked out pretty well. She voluntarily gave us care and custody of the boys, so we make sure they go to the doctor and get their shots and go to school."
The arrangement "takes that stress off of her," he said, but puts it squarely on his and his wife's shoulders.
The couple, who each have busy careers, have had their grandsons fully in their care for about six years.
"We balance our schedules," he said. "After raising three daughters, it's a little different going back to being a parent again."
The boys are involved in sports, Boy Scouts, Cub Scouts and church group activities.
"They're going, going, going," he said. "Grandma and Grandpa keep pretty busy."
When he or his wife have to travel for work, "we pack up the boys and take them along, if we can."
The boys visit their mother, who's 28, and "pretty much all realize (the nature of the situation). We don't hide anything," he said. "They say, 'Mom's at school.' "
But those visits have the potential to trigger a relapse, he said.
Recently, the oldest child told his mom about a school dance he attended.
"She got pretty emotional," he said. "I think she realized, 'Oh, my gosh, he's old enough to go to a school dance."
Looking back, he said his daughter "was only 16 years old when all this happened. The maturity of your brain basically stops. She never had a chance to grow up. It's almost like another kid when you get them all together."
Searched for help
When their daughter's addiction first became evident, the Stroklunds sought help everywhere they could.
"We looked for help for our daughter for months and months and months, and couldn't find any help," he said.
Because of his family's experience, Stroklund is committed to shedding light on the opioid crisis and, especially, to reducing the stigma that surrounds those caught up in it.
He serves on the Governor's Behavioral Health Planning Council and on the Minot mayor's committee dedicated to finding answers to alleviate the problem.
He takes every opportunity to speak publicly about his family's ordeal, and what needs to be done to address the opioid crisis, he said.
About two-thirds of people in North Dakota have been affected by substance abuse, he said.
"Recovery care is the big thing we're missing in North Dakota."
His daughter has good days, and then something happens that triggers a relapse, he said. "Relapse is so common, especially in the opiate world," he said.
The statistics are grim, said Dr. Emmett Kenney, child and adolescent psychiatrist with the Red River Behavioral Health System in Grand Forks.
"Opiates are extremely addictive," Kenney said.
The rate of those who get and stay sober is less than 10 percent, he said.
The opioid crisis that has swept the nation is continuing to harm or destroy lives at a troubling rate.
In North Dakota, the number of deaths from opioid overdose is increasing, research studies show.
In 2016, there were 77 overdose deaths in the state compared to 20 in 2013, according to the Centers for Disease Control and Prevention, which showed in preliminary data that 85 people died from drug overdose in 2017.
"At the regional level, the number of individuals getting placed in a living arrangement other than with their parents, has been increasing, said Michael Dulitz, coordinator of the Opioid Response Project, at Grand Forks Public Health.
Exact figures are unavailable, he said. "These are sensitive subjects. The stats remain anonymous."
"Children who are living with a parent with an addiction have a three-times-higher risk to experience physical or sexual abuse," he said.
They may also feel guilty-seeing themselves as the main cause of the problem-and suffer bouts of depression, anxiety, confusion and anger.
Children who see parents using drugs are more likely to use drugs themselves, even though they know all too well the adverse effects, said Kenney.
'Normalizing' their lives
These days, the Stroklunds' role is "all about normalizing the children's life as much as possible," said Stroklund, 56.
At a time in their lives when others their age are able to enjoy hobbies or leisure travel, the Stroklunds are taking the grandkids to various activities.
They are not immune from waves frustration and resentment at times, he said. "There are days when I want to bite my daughter's head off."
They also pay attention to things like insurance coverage, as it applies to the kids, "to make sure that they're going to be OK," he said.
And they think about what will happen if they are not around to take care of them.
That's not uncommon, said Kenney.
"When you talk with these grandparents, you find out that they are often aware of their own aging," he said. "For example, if they're 65, they're thinking, who's going to take care of these kids when I'm not around?"
Having worked with thousands of families and patients over 24 years in this field, Kenney said children in these situations experience "a loss of innocence."
"At 10 or 12 years old, they've had to make sure that Mom or Dad is awake and not dying," he said. "The child becomes the 'pseudo-parent.'
"At 13 to 15 years old, when they should be investing in their own independence and peer groups, they're having to be the parent for their parent. They haven't had enough nurturing themselves. The child is used to being Mom's rescuer."
If the children end up with their grandparents, they may have difficulty giving up that role, Kenney said. "There's a role reversal, role confusion. They have to be the kid again."
These children also deal with questions of permanence and consistency in relationships, he said. "Will Mom be back and healthier in a few weeks, or will it be long term?"
"What's interesting to me is that children (who've been in these situations) often turn out to be very good parents," he said.
A major commitment
As substitute parents, the Stroklunds don't think of their roles in terms of weeks or months, but in years.
Asked if they expect to be "parents" to their grandsons for the short or long term, Stroklund said, "I don't know. We plan for both. ... We hope things will be better next year."
For the Stroklunds, it's all about family, he said. "You've got to be there for them."
He is hopeful that bringing addiction to the forefront and talking about it openly will go along way to reducing the stigma around the individuals and families who are affected, he said.
"My daughter didn't wake up one morning and say, 'I want to stick a needle in my arm.' "